Making treatment decisions at the end of life

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This guide provides information on some of the topics that can arise when someone is seriously ill after a stroke or nearing the end of their life.

Consenting to treatment

Normally patients have to give consent to any treatment, but if someone is unable to respond while they are having a stroke, doctors will give emergency treatment required. Once the person has recovered and is able to understand the situation, they may be able to agree to or refuse treatment.

However, if someone is unable to understand their own condition after a stroke, doctors have to try to speak to the person’s relatives or friends before making a decision about the person’s care. Doctors will give treatment if they believe it’s in the person’s best interests

Deciding to withdraw treatment

If someone can’t make decisions themselves and they are being kept alive with life-support treatments, such as being on a lung ventilator, the choice to continue treatment needs to be based on what the person’s best interests are believed to be. Healthcare professionals should discuss the options with relatives and friends. If an agreement can’t be reached, the case may need to go to court for a legal ruling.

In some cases, doctors may suggest withdrawing treatment, such as if someone has been in a state of impaired consciousness for at least 12 months. Legally, doctors are not able to take active steps to end a person’s life. But sometimes medical professionals will recommend that the best thing to do is to stop active treatments such as antibiotics to treat pneumonia, make the person as comfortable as possible and let nature take its course.

Or it may be that doctors want to continue treatment but the family may feel that this would only prolong their loved one’s suffering. Whatever your views, it’s important to have a discussion with the doctors. Their goal will be to do the right thing for the person who has had the stroke

The right to refuse treatment

Advance decision (England and Wales) It is possible for someone to make choices in advance about refusing treatment, in case they become unable to make a decision in the future. An advance decision, sometimes known as a living will, is a written instruction about refusing specific types of life-sustaining treatment. This can include things like being on a ventilator, having CPR (chest compression to restart your heart), or antibiotics. An advance decision is legally binding provided you have the mental capacity to make the decision, and has been signed and witnessed.

Advance statement (England and Wales)You can also create an advance statement, which sets out your preferences, wishes, beliefs and values about your future care. It’s not legally binding, but it provides a guide to those who need to make decisions about your care if you lose the ability to make choices yourself.

Advance decision (Scotland and Northern Ireland)In Scotland, this advance decision is known as an advance directive. It is not legally binding, but it is very likely to be respected by medical staff and relatives. Scottish courts would be likely to respect the views in an advance directive provided the person had the ability to make their decisions when the directive was written.

In Northern Ireland, like in Scotland, if you set out what you want to happen in an advance decision document that is signed and witnessed, it will make it much more likely that your wishes will be respected by family members and medical and legal professionals if you do become unable to make decisions about your own treatment.